Outline

Objective: Cavernomas represent 10–20% of all intracerebral vascular lesions. Most common presenting symptoms are seizures, headache and focal neurological deficits. The aim of the study was to analyse outcome after surgery of solitary supratentorial cavernomas in a large single institution series.

Methods: We retrospectively analysed charts of 99 patients with single supratentorial cavernomas operated upon between 10/96 and 12/07. Mean postoperative follow-up was 38 months (1–111 m.); one patient was lost to follow-up. Size and location of the cavernoma as well as the presence and size of a haemosiderin rim or oedema were analysed using preoperative MRI. Pre- and postoperative clinical examinations, age at epilepsy onset, age at operation, type of symptoms, type, frequency and duration of epileptic seizures, extend of surgery and approach; surgical complications as well as postoperative imaging studies were assessed.

Results: Preoperatively, 49 patients (49.5%) presented with seizures, and 28 individuals (28.3%) showed focal neurological deficits. The main indication for surgery in the remaining patients with no or mild and transient symptoms was signs of recent haemorrhage on MRI. 89 of 99 patients (89.9%) were neurologically unchanged or improved during follow-up. Five patients showed a new visual field deficit, three individuals had a mild aggravation of their hemiparesis and two patients showed memory deficits postoperatively.

There was no case of new haemorrhage postoperatively. 43/49 patients (87.8%) had a favourable seizure outcome (Engel class Ia: 35 (71%), Ib: 2, Ic: 6). Five cases were classified as Engel class II and one case as Engel class III, respectively. Three patients without preoperative epilepsy developed new seizures postoperatively.

Conclusions: Surgery of single supratentorial cavernomas shows a favourable neurological and epileptological outcome. Further haemorrhage can be prevented. Therefore, resection should be considered in patients with symptomatic cavernomas and cavernomas with evidence of recent haemorrhage.